De Giorgio Giuseppina, Ruberto Stefania, Firenze Caterina, Quartesan Roberto
Unità per la Clinica e la Terapia della Cefalea Psicosomatica, Sezione di Psichiatria, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia.
Riv Psichiatr. 2010 May-Jun;45(3):179-87.
Each person has an inseparable body-mind unity, with psychic factors that can also manifest themselves through changes in the functions of the body, and with changing somatic states that contribute to mental experience. This explains why somatic symptoms fall within psychiatry. When a patient complains about physical symptoms, it is essentially an integrated, multidisciplinary diagnosis which is used to identify the various factors (biological and psychological) which worsen the disorder, and a psychiatric dimensional approach is used to integrate the descriptive symptomatic diagnosis with the psychostructural diagnosis. The same symptoms, in fact, may underlie different psychological dynamics that direct the treatment and determine the prognosis, as explained in three clinical cases that we described. The literature on headaches reports a high rate of co-morbidity between migraines and psychiatric disorders, but doesn't take into account the fact that often the symptom of headache is part of the disorder, even when it presents on its own. In conclusion, a holistic approach is needed for the patient to be diagnosed as having a "psychiatric" form of headache. A medical examination of the illness leading to a diagnoses is essential, according to the criteria of the International Classification of Headache Disease (ICHD-II). In clinical practice, we have integrated the descriptive diagnosis (ICHD-II mini-Plus) with the psychological (Diagnostic Criteria of Psychosomatic Research - DCPR) and psycho-structural (Kenberg's interview, Minnesota Multiphasic Personality Inventory - MMPI) diagnoses. The clarification of the dynamics underlying the definition of symptoms and the role played by psychological factors has influenced the identification of therapeutic objectives and in the identification of the most appropriate strategies.
每个人都有不可分割的身心统一体，其心理因素可通过身体功能的变化表现出来，而身体状态的改变也会影响心理体验。这就解释了为什么躯体症状属于精神病学范畴。当患者诉说身体症状时，本质上是一种综合的、多学科的诊断，用于识别使病情恶化的各种因素（生物学和心理学因素），并采用精神病学维度方法将描述性症状诊断与心理结构诊断相结合。事实上，正如我们所描述的三个临床案例所示，相同的症状可能基于不同的心理动力学，这些心理动力学指导治疗并决定预后。关于头痛的文献报道偏头痛与精神疾病的共病率很高，但没有考虑到这样一个事实，即即使头痛症状单独出现，它往往也是疾病的一部分。总之，需要采用整体方法来诊断患者是否患有“精神性”头痛。根据《国际头痛疾病分类》（ICHD-II）的标准，对导致诊断的疾病进行医学检查至关重要。在临床实践中，我们将描述性诊断（ICHD-II迷你加版）与心理诊断（心身研究诊断标准 - DCPR）和心理结构诊断（肯伯格访谈、明尼苏达多相人格调查表 - MMPI）相结合。对症状定义背后的动力学以及心理因素所起作用的澄清，影响了治疗目标的确定以及最合适策略的确定。
